Saturday, May 26, 2012

‘Really quite disastrous’

By Editorial Board, Saturday, May 26, 5:23 PM

AS THE WORLD’S worst outbreak of cholera continues to ravage Haiti, international donors have averted their gaze.
Humanitarian relief groups, short of cash, are folding their tents. A pilot project to vaccinate Haitians against the disease, recently undertaken at a cost of $400,000, reached only 1 percent of the population, with no immediate prospect of expansion. Of the 100 or so cholera treatment centers that sprang up around the country after the disease was detected 19 months ago, fewer than a third remain.
The United Nations’ humanitarian coordinator for Haiti, Nigel Fisher, said this month that donors have so far met just 9 percent of the $230 million U.N. appeal for 2012 — not only for cholera but for a range of relief programs including flooding, tent cities and food insecurity. “It’s really quite disastrous,” he said.
Meanwhile, cholera’s deadly toll has mounted in the Western Hemisphere’s poorest country. Unknown in Haiti for a century before the first cases appeared in October 2010, cholera has now killed 7,100 people, infected more than 550,000 and hospitalized nearly 300,000.
It has also spread across the border to the Dominican Republic, killing more than 400 people there. Five percent of Haiti’s 10 million people have already been infected, and health experts estimate that 200,000 could contract the disease this year.
Epidemiologists now believe that cholera was unwittingly introduced in Haiti by Nepalese troops in the U.N. peacekeeping force, whose encampment lacked adequate sanitation facilities. After that, there was no mystery about the conditions that enabled the disease to flourish. Spread by water or food that has been contaminated by fecal matter, it raced through a country where just a third of the population has safe drinking water and fewer than one in five people have access to latrines and modern sanitation.
The tragedy is that the solution is equally well known but costly. Haiti needs modern water and sanitation infrastructure, an undertaking that might cost $1 billion. But while donors tend to respond generously to emergencies, such as the earthquake that devastated Haiti in early 2010, they lose interest in long-term fixes of the sort that would deal decisively with cholera.
Groups representing thousands of Haitian cholera victims have demanded millions of dollars of reparations from the United Nations, citing the disease’s introduction by the peacekeepers. But the United Nations’ money, if it manages to raise any, would be more profitably spent on a much more aggressive cholera vaccination program.
It would take just $40 million to administer oral vaccines to every person in Haiti. That’s about the same amount a U.S. presidential campaign collects in a month or a footwear manufacturer recently agreed to pay to settle charges that it exaggerated the fitness benefits of its shoes. But until recently, international health organizations dragged their feet on vaccines, worrying they might be too expensive or difficult to administer. They preferred a systemic infrastructure fix.
That’s simply indefensible. It may take many years to provide adequate water and sanitation systems in Haiti, but a two-dose vaccine that costs $4 per person can be manufactured right now. Granted, there will be logistical hurdles to overcome in procuring the vaccine, distributing it and ensuring it is properly ingested by a poorly educated, widely dispersed and largely rural population. But to do nothing in the interim is immoral.

Saturday, May 19, 2012

Wednesday, May 16, 2012

The situation is serious. The Nation is not immortal, it is dying. The country is short of breath, [...] he world attended, without illusions, to the sad spectacle of Haitian political impasses that succeed by partisan rivalries and sterile, of inquisition on issues foolish such as dual citizenship, while Haiti needs the cooperation of all his daughters and all his son, to see them answer to the appeal of the ancestors, so often sublimated, become a dead letter: 'Unity is strength!' Of the union we have nothing to do, we prefer the division and endless confrontations. [...] we have only for force that of sinking further our land and a population in the poverty, the abject poverty, the misery, the confusion.

It happens to me, I confess, to be ashamed of this pathetic betrayal of our achievements and our conquests of yesteryear. Betrayal of our noblest aspirations to freedom, equality and fraternity. Betrayal of our highest dreams to break all the chains.

I hurt in my heart of Haitian to be challenged by them, smile, pulling the line and only see in Haiti a country ruined, deliquescent, without compass, without State, without a future, a rotten trunk, a world of corruption and some don't hesitate to describes it, of incapable.

Sunday, May 13, 2012

The cholera epidemic in Haiti, which began in late 2010, is bad and getting worse, for reasons that are well understood and that the aid community has done far too little to resolve. A chronic lack of access to clean water and sanitation make Haitians vulnerable to spreading sickness, especially as spring rains bring floods, as they always do. Summer hurricanes are bound to come; more misery and death will follow. The Pan American Health Organization has said the disease could strike 200,000 to 250,000 people this year. It has already killed more than 7,000.

Doctors Without Borders said this month that the country is unprepared for this spring’s expected resurgence of the disease. Nearly half the aid organizations that had been working in the rural Artibonite region, where this epidemic began and 20 percent of cases have been reported, have left, the organization said. “Additionally, health centers are short of drugs and some staff have not been paid since January.”

It gets worse: the Centers for Disease Control and Prevention released a report this month that cholera in Haiti was evolving into two strains, suggesting the disease would become much harder to uproot and that people who had already gotten sick and recovered would be vulnerable again.

The United Nations bears heavy responsibility for the outbreak: its own peacekeepers introduced the disease through sewage leaks at one their encampments. Before that, cholera had not been seen in Haiti for more than a hundred years. But the United Nations humanitarian coordinator for Haiti, Nigel Fisher, admitted in an interview on May 3 that “what we are doing is sort of patchwork, Band-Aid work on a fundamental problem.” While two nongovernmental organizations began a vaccination program last month in Port-au-Prince, it is only a trial that will protect a tiny part of the population. It is a worthy effort that will save lives, but not a substitute for basic water and sanitation.

A letter circulating in Congress calls on Susan Rice, the United States ambassador to the United Nations, to urge the world body to fully commit to eliminating cholera from the island of Hispaniola. The C.D.C. estimates that adequate water and sanitation systems will cost $800 million to $1.1 billion, a sum that can surely be wrested from the billions that nations have pledged to Haiti, though contributions have flagged as attention to the crisis has faded.

The Congressional letter echoes a demand from the Institute for Justice and Democracy in Haiti, a human rights group that has sued the United Nations on behalf of 5,000 cholera victims. The U.N. and the international community have a responsibility to meet the crisis head-on. There are pledges to fulfill, dollars to deliver and lives to save.

Friday, May 11, 2012

On Monday morning of this week I took a deep breath as I walked into malnutrition clinic. I wondered if Sarah had survived the weekend.

But lo and behold there was mom sitting with Sarah on her lap. And Sarah looked pretty good considering that she weighs five pounds and lives in Soleil. She was not crying and mom was breastfeeding her.

What a pleasant surprise...especially for a Monday morning.

I asked mom if she had called Kim and she mumbled that she had not because she "had a headache". (Kim had offered to provide Sarah with formula on a weekly basis for no charge.)

So I told mom to stay seated on the bench with Sarah and I started general pediatric clinic in an office down the hall.

I had e mailed a new acquaintance the day before and told her that I needed help with Sarah. Several hours later my new friend from Canada showed up on a motorcycle and I explained to her in more detail the "dilemma of Sarah" and asked her if she would help try and solve the problem. She said she would do what she could. So I introduced her to mom and Sarah on the wooden bench in the malnutrition clinic.

I went back to my office and continued seeing patients.

My friend spent about two hours talking with mom and making phone calls. And by the end of the morning she had devised a plan for mom and Sarah to go to We Advance in an adjacent slum on Wednesday morning.

We Advance is a clinic in Wharf Jeremie (an adjacent slum to Soleil) that sees 100-150 patients a day and is open 4 days a week. It consists of a Haitian medical staff and international volunteers. Its main focus is maternal health and baby well being.

And our personal goal here is to interest mom in feeding Sarah on a full time basis.

At the end of the morning in clinic, Sarah's mom walked into my office and asked me for money and once again I told her no. But I told her to come back the next day and he agreed. I gave mom another can of Similac and she was on her way back to her shack on the Soleil wharf.

The next day on Tuesday at noon mom showed at clinic with Sarah. But Sarah had her hungry desperate cry going on again. I asked Mom if she had been feeding her and she said no that her breast and back were hurting.

I asked mom to breast feed Sarah again. Right now. Mother kind of reluctantly pulled out her right breast and Sarah latched right on and began feeding. She was "starving" as usual. And mom's breast did have milk.

I asked mom if she really wanted Sarah to live. She said yes she did. I told her that the way things were going was that Sarah was slowly dying from lack of milk. I asked mom if she wanted Sarah to take care of her when she was an old lady in the slum. Once again mom responded yes.

Mom's sister was present for this office visit. The sister has her own problems with her own baby entered in the Sisters malnutrition program. (Sarah is too young to be in the program.) I explained to mom and her sister again where they could find We Advance in the nearby slum and wrote it out clearly on a piece of paper. Even though neither of them read, I thought it could be helpful if they handed the piece of paper to someone near We Advance when they go to Wharf Jeremie. The sister assured me that she would go with mom and Sarah the next day.

Thursday, May 03, 2012

Yesterday morning in the pediatric clinic a mother came into my office and sat down with her baby wrapped in a blanket. She had not checked the baby in at the front desk and offered no dossier for me to look at. The dossier is the medical chart that is supposed to transmit information from one visit to another.

This was a "red flag" to me right away. And there were three Haitian pediatricians seeing patients in their offices. Why did mom pick me?

Mother quickly uncovered the baby before I could tell her the important need to "make a dossier". She showed me her six week old baby girl Sarah. The baby's skin was hanging off her and she had the shrivelled little old person look due to severe malnutrition called marasmus. And she was also eaten up with scabies.

I weighed Sarah. Five pounds.

Mother said that she lives in a shack on the Soleil wharf just a few blocks from the clinic. She and Sarah and Sarah's other seven siblings live together in a tiny place.

Two of Sarah's siblings have died. The father of Sarah's brothers and sisters is also dead. And mother told me she had not seen Sarah's father since she was pregnant with Sarah. She referred to Sarah's father by his nick name in the slum.

Mom hung her head down and talked quietly explaining how she has no money to buy food for her kids and her breast is dry for Sarah. This story is ubiquitous in the clinic and throughout Soleil and is partly true. I hear this story every day.

However, this mother seemed well fed and quite intelligent. She looked poor, but she was definitely a little different than the normal Soleil wharf person. I noticed that her eyes seemed to dart around a lot as she was telling me her problems. She even looked out the door a couple of times.

I agreed she has many problems. However, her main problem is Sarah.

It didn't take much time to find out that Sarah has a very loud and hungry scream. So the nutrition nurse mixed up some Similac and put it into a tiny five ml plastic cup and her mother competently dribbled drops of milk into Sarah's mouth. Her distress and cry ceased almost immediately and the look of desperation disapperared into a content face. You could see her distress and her hunger pain abating. Sarah stared directly into her mother's eyes like she was saying "thank you".

So I thought here is another baby starving just 90 minutes form Miami in the hell of Cite Soleil. And the Sisters who run the clinic have a malnutrition program but don’t admit babies until they are six months of age. So Sarah is too young to be enrolled since she is only six weeks old.

I examined Sarah and treated her with some very diluted down medication for her scabies. I sent her mom home with some Similac and told her mom to bring Sarah back in the morning. Her mom promised me that she would.

But I had bad feelings about the mother.

Last night I called a close friend of Maria’s and mine. I will call our friend Kim.

Kim and her husband have an orphange and nutrition center in Port-au-Prince and I explained to her about Sarah. Kim has heard countless similar stories and she said that she would come to Soleil in the morning and evaluate the baby. And if all worked as planned she would take Sarah and her mother back to the orphanage and supply her with food.

So this morning when I walked into clinic, Sarah and her mother were seated on the bench outside my office. But Sarah was screaming her desperate hungry cry. I asked mom if she had given Sarah the powdered milk this morning and said she had not because she had no bottle.

This angered me to hear this. What was mother thinking? Her baby needed nutrition.

And Sarah proved she did not need a bottle yesterday in the clinic. She had been fed from a little plastic cup. So the nutrition nurse and I mixed up some more Similac which Sarah devoured quickly from the tiny cup and went to sleep.

What could mom be thinking? Why wasn't she feeding her starving baby girl?

Kim showed up. So we sat next to mom and Sarah and Kim explained what she could do for Sarah. Mother said no, that she did not want her baby in an orphanage. And when Kim said that she would take mother and Sarah to the orphange today and give her one weeks worth of powdered milk AND transportation money back to Soleil, mother refused that offer also.

I stared at the mother. What is with this Soleil mother? She has a beautiful baby that she is not able to feed or is choosing not to feed.

In the US I would have called DCFS yesterday and admitted Sarah to a hospital for potential neglect. And even though there is an equivlanet agency here in Haiti, it is way too overworked and understaffed and there is no way it would respond to Sarah in Soleil.

So I pleaded with the mother to go with Kim. She refused again. She said she had to get home to get her other kids to school and the "streets are dangerous". But she made no move to leave.

I thought what if I had offered the mother some money so Kim could take her and return her to a good nutritional state and then return her to the mother. I would be bribing the mother to try and save Sarah's life. I concluded this this would be a very bad idea, because it would appear that we were “buying a Haitian baby”, when in fact we were not. But that is how it would appear.

So Kim gave her her phone number to call if she was ever interested feeding Sarah with a constant flow of milk. Mom said she would consider this although I had my doubts.

So Kim left. And I went and sat in my office and closed the door so I would not have to look at the mom and baby Sarah as they sat on a bench just a few feet from me.

I was angry with the mother.

I thought she is using Sarah as a bartering tool to get some money....or to get anything. She is playing the system. Yes that is it. She is barely keeping Sarah alive to see what she can get from anyone.

Or maybe Sarah’s long lost father told the mother not to give the child away or he will kill the mother? Is the mother afraid of the father even though she says she does not ever see him? Has she been threatened by him?

I opened the door and called mom into my office again with Sarah. I examined Sarah again. I explained that Sarah is dying simply due to lack of food. I told mom to reconsider Kim's offer. She said all her kids are hungry and asked me for money to feed them. I told her no...I didn't want Sarah to be her bartering chip.

I then met with a Haitian Catholic Sister who works with the malnourished kids and explained to her Sarah’s situation. The Sister just looked at me and said the mom wants money. But Sister talked very matter of factly with mother and explained that she needed to call Kim tomorrow. Mother told Sister that she would.

Two hours later mother was still walking around the clinic in front of hundreds of other slum mothers carrying pathetic Sarah in the dirty blanket. Mother acted like she had no problem in the world. And the other mothers just stared at her. And she hadn't left to make sure her kids made it through the dangerous streets of Soleil.

Sarah, if I could do something better for you, I would. I just don’t know how. Poverty does bad things to people's bodies, minds, and souls that people like me don't understand.

Hopefully, your mom will reconsider, and bring you back tomorrow so we can call Kim and you can eat.

Tuesday, May 01, 2012

The people in the photo are pumping water from the underground water table in Drouillard. Some have the means to treat the water with Aquatabs and chlorox, and some don't.

MSF-Drouillard Cholera Treatment Center (CTC) is just down the street from this site.

The CTC has 57 inpatients tonight and had 29 new cholera admissions today (May 1, 2012.) There was one death this morning and one death this afternoon of "people who came too late". The vast majority of the patients are from Cite Soleil.

This CTC is very well run. They have great security at the front gate. Chaos is not tolerated.

The tents are very clean. The many different locations to wash ones hands have buckets filled with the right concentration of chlorox.

The supplies are neatly kept in the tents.

The patients look much better than the ones that flooded the CTC at Hopital Albert Schweitzer last summer.

Tonight there are four Haitian nurses working with one Haitian doctor.

An MSF official told me that they are getting more daily admits than they did a year ago at this time and he said he did not know if this was a good sign or a bad sign. It is good if people are coming earlier (which is my guess), and it is bad if there is more cholera.